Multiple Guesses

Sorry the posting has been so scant as of late. I just don't feel like there's much of anything to write about.

Today was our annual in-service exam. Every year during my residency I will be subjected to the American Board of Emergency Medicine's guantlet of questions. After residency, graduates are supposed to take a board exam to be licensed in their particular specialty. Taking this test is supposed to be helpful with preparation. I didn't really do much to prepare for it this time. I have been trying to keep up with my weekly assigned reading, but I don't always get everything done. I should be reading more about the patients that I've seen during the day, but somehow I just don't want to deal with it when I get home. The test was 225 questions long, and I probably finished the exam among the first third of the group. That doesn't really mean anything. Usually, I will quickly scan through my answers after I take a multiple choice exam, but I just wanted to get out of there.

My understanding is that as long as I show improvement every year, that is all that matters. I think I may have set the bar pretty low today. Some of the questions I knew right away what they were looking for, but there were many that I just had no clue about. Many times I have felt like I am just plugging along this year, not really learning much. However, as I was working my way through the test, I kept remembering particular patient encounters and tried to remember how we handled each particular situation. I guess I am learning, it just doesn't seem like it when there is such a vast expanse of things to be knowledgeable about. Part of my frustration comes from my continual inability to retain information. Many times I feel like I am forgetting old information faster than I am learning new stuff.

No Sex In the City

On the now-canceled show "Sex In the City" four career women parade about from bar to bar, always dressed to the nines, leaving a trail of men in their wake. Somehow, when I go out on the town, there's never any intelligent conversation or men worth keeping.

Last night we went out again. I thought it would be a more fun experience as I had put McNeedy on a plane outta here earlier in the week, and there were some guys going in the group, so I didn't think I would have to be the one carrying my coworkers home. The night was boring, but going well enough when I turned around and Coworker #2 was bawling again. She ended up crashing at my house overnight. I didn't really want her to, but I was kind of stuck as she was in no condition to drive home, and the single guys in our group didn't really want to cart her around, either.

I was supposed to go skiing again today, but I was awakened by sounds of an asthmatic drunkard coughing all night long, so I didn't really sleep well. She was still passed out this morning, so I couldn't very well kick her out and dump her back at her car. By the time she woke up, the whole morning was gone. I wasted the afternoon by napping to make up for the poor sleep. What a waste of a day off. Maybe I'm better off only going out with couples, so I don't end up having to babysit drunken single chicks.

Not Exactly a Snow Bunny

I went downhill skiing with some friends today. I don't know how to ski. Apparently, it's not something that you can just slide off a lift chair and take to naturally. At least I can't. I attempted skiing once two years ago. This time I thought I would be better prepared as my friend said that he used to work as a ski instructor. He forgot to mention that he doesn't believe in bunny hills. We went straight to the trails. He and his wife coasted downhill with ease. And then there was me...

I don't mind falling. It is the getting back up part that stinks. I have improved greatly in my turning techniques, however I still get really scared any time I start to pick up some speed. Snow plowing down a slope takes a lot of muscle work. Scissoring back and forth across the mountain rather than down is a LOT slower.

And my friend? While his wife and I enjoyed a quick lunch at the lodge, he checked out all of the other trails and decided that they weren't anywhere near as tough as the standards he was used to. Next, he took us on a blue square trail... and then a black diamond trail. The falling didn't really seem to let up any.

After three runs, I was toast. My legs were quivering and my left knee is sore from the time I veered off the course into the powder and buried myself. It is really, really hard to stand back up again. I think that people who are good at downhill skiing probably don't get much of a workout. As for me, I will definitely be taking the elevator tomorrow as the stairs just might kill me. Apparently, there were perfect conditions today: lots of fresh snow, no ice.

The good thing about finishing up before your friends is you can sit in the lounge and sip something lovely called a SoCo Cocoa... which involves hot chocolate and quite a bit of Southern Comfort. They want to go again next weekend, but I have a feeling I will still be limping around then.

Roses, Bagpipes, and Sloppy Kisses

Last night was really bizarre. McNeedy recently broke up with her boyfriend as did another random coworker. They both descended on me, wanting to go out to drown their sorrows. I threw on a bulky sweatshirt, offered to be their designated driver, and geared myself up for a night of adult-sitting.

I am not a regular bar-goer, so I drove us to the one bar in town that I am familiar with. We secured ourselves seats at the bar, and McNeedy began talking up the bartender/manager. She was rewarded with a free beer. A stranger sidled up to us, and began chatting us up. I sat between my two bitter companions. The bartender decided that I was "the Boss" of the group and started to get friendly with me. He helped us dispose of the creepy stranger, and tracked down drunken Coworker #2 when she wandered off to dance at a nearby club.

The bartender, who had also been drinking the entire night, came out from behind the bar. He bought me a rose from a flower vender and we were serenaded by a random friend of his who came in with a set of bagpipes. McNeedy and Coworker #2 continued to get sloppy. The bartender kept checking up on us throughout the night, and he stealth-kissed me a couple of times. Then he said something about me being to much of a worrier, and how he was going to give me something to take home and smoke later to relax! I declined.

Finally, Coworker #2 stumbled back in and we closed our tab. McNeedy settled up, and bragged about how her flirting had gotten us a much lower bill. Meanwhile, the bartender slipped me he phone numbers and tried to arrange to meet me in the ally to "give me something for the road." By this point, McNeedy was puking and Coworker #2 was in tears. I tried to find the guy on the street to decline his stash yet again, but couldn't find him. Everyone got home safe, but I don't think I'll be going out with the girls anytime soon... not to mention returning to that bar! The guy was witty enough when he was sober, but I'm not going to call him. The bad thing is that people in our department sometimes head there with attendings after a busy shift to hang out. Hopefully my name doesn't come up.

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Despite getting home close to 2 am, I was up by 8 this morning. I immediately paged my one normal friend in town and demanded that he take me to breakfast, so I could yell at him for not being available to go out with us last night.

We went to an indoor driving range and hit golf balls for a while. I'm not very good, and actually had not touched a club in years. It was fun, especially as it was in an tent-like dome. If you hit the ceiling hard enough, large chunks of ice would loosen and slide down the opaque parachute material with a crash. Afterwards, the day was killed with watching movies and eating too much at dinner. I guess I'm not a very exciting girl. I would much rather have a calm day like today than the mess of last night.

Tiny Hearts

Yesterday there was a Harlem Globetrotter on the floor. I think he was there to cheer up the kids, but I didn't see him do any tricks. We have quite a few malnourished infants in the nursery, so the nurses took a bunch of pictures of him holding some of our littlest ones. One of my kids is only about 5 lbs even though she's 3 months old, so she was smaller than the basketball!

It snowed about 10 inches overnight and another 4 since I cleared the driveway this morning. Conference was canceled today, so I unexpectedly got a day off. Mainly I've just been lounging around. I tried removing some of the wallpaper from the guest room, but it's a much bigger project than I had figured on. I tried scoring it first and then applying a chemical spray, but it just doesn't come off in large pieces. This may be because the previous owner painted over the wallpaper, so it's kind of thick and unyielding. I tried also steaming it with an iron, but my iron only steams when it is horizontal, so that doesn't work. The plan is to get all of the wallpaper off this winter so I am all ready to paint when the weather's warmer.

It's nice that I ended up with the day off because I have another 24-hour day tomorrow. Hopefully, the weather will discourage too many people from coming or going.

I don't really know what to do with the entry labels. I can't imagine that my entries would be anything that anyone would be looking for by topic.

I'm Rubber, You're Glue...

I sat there this morning and kept my mouth shut. Around me there was smirking. I took a long swig of my coffee. It was too hot, and the liquid burned as it went down my throat, through my esophagus, and right into my stomach. Tonight my tongue still has the angry, sensitive sensation from the scalding. However, sipping at my coffee was the only way I could keep quiet.

I hate morning report. Morning report involves sitting around a large conference table and discussing a case that was admitted overnight. Typically much bashing of the Emergency Department ensues. Today's case was a four-day old infant with bloody vomit who also had a fever. A full septic workup was started looking for a source of the fever by checking the blood, urine, and CSF. The baby was started on antibiotics and admitted to the floor.

The head pediatrician started in on how the cause for blood streaks in the vomit wasn't worked up very thoroughly, and how he thought that the antibiotics weren't really necessary as the infant was being monitored in the hospital. Then he made some snide comment about the ER starting antibiotics as we just wanted to avoid lawsuits in the event of a bad outcome.

Does he consider the unnecessary death of an infant a "bad outcome"? Why is it ok to take chances with someone's child? Our job in the emergency department is to look for life-threatening conditions. Yes, most of the time we see people who don't have a doctor or can't get an appointment. However, in the event that we do find or suspect something serious, we act on it. Otherwise, it would be called the Let's-Just-Order-A-Shitload-Of-Tests-And-See-What-Your-Dumbass-
Doctor-Wants-To-Do-In-The-Morning Department.

Granted, there could have been a little bit more of a workup done for the vomiting. However, the kid was already being admitted to the hospital, and the mother gave a history that her nipples were chapped and sore from breastfeeding. The blood could have been swallowed or it could have been coming from the baby. There's a test that can distinguish maternal blood from the baby's blood that could have helped with this, but it takes awhile to get those results. Is it asking too much for their department to do something more than just sitting back, observing the patient, and waiting for our results to come back? Does it pain them to have to do some work?

This is a problem that I will continue to face. When patients are passed between departments, either side often has issues with the other. However, I think it's rude for them to be so critical when they know that I'm sitting right there. It also didn't help to improve my mood when it turned out that many of their residents were clueless as to when to start the workup, or how to even do it.

Sometimes it's hard to keep a poker face when you really just want to tear someone apart.

Lights and Sirens, part 2

Maybe I had this coming for previously mentioning that I have never been pulled over by a police officer. However, I think it had nothing to do with my speeding last night, but rather my friend's bad luck. This guy has the worst luck of anyone I've ever met. He is very smart and conscientious about caring for his patients. However, a while back he got in some BIG trouble with administration about a confidentiality issue. The next month he had the mishap with a procedure, in spite of being supervised by multiple attendings. I am sure all of us will eventually run into the sorts of things that he is, but he just seems to be hitting them all at once. Maybe I'll ban him from riding in my car.

One of our friends is in the middle of a breakup, so we were at her house for moral support. I was very tired and was almost at his house to drop him off when I saw the lights in my rearview mirror. The officer informed me that I was going 41 in a 30 mph zone, but that he mainly pulled me over because I have tinted windows on my car. Huh? Then he said something about how they were just stopping a lot of people at that time of night to make sure nobody was drinking. So I had to do a bunch of counting backwards and dexterity tests with my hands... which I passed, in case you were wondering. Fun stuff.

So now I'm confused. Is it ok to speed as long as you don't have tinted windows? And my windshield is not even tinted. The rest of the windows have a light tint which was ok back home, but apparently is not a good thing here.

Running Late

Usually, I get to work about 15 minutes before I'm supposed to start so I can kind of get a grip on my surroundings or spend a few minutes chatting with someone in the locker room without being frantic about getting somewhere.

On Monday, the first patient that I met was a 13 year-old boy. He was unresponsive. He had been in the car with his dad when their tire blew out and they flipped upside-down into the frozen waters of a nearby creek. His father died that night. The boy was taken to our hospital, and several tests had shown that there was no brain activity. His mother, who had not been in the car that night, made the tough decision to stop all medical interventions, including fluids and nutrition. As he was seizing uncontrollably, there was little hope of him regaining any function. Over the weekend, one of the nurses had an issue with fluids being withdrawn, and decided to restart his IV without having an order to do so. I don't know how that issue was handled, but this is what I walked into. I briefly met the mother, examined the patient, and continued on with my list of patients. Fluids were again withdrawn. Tuesday I had off, and Wednesday was a conference day so I was excused.

Today, as I walked in, I was told that the patient had just died. I think that I have never been so thankful to be running late in my life. By the time I got there, he had already been pronounced, and the poor overnight resident had to stay late finishing up the paperwork. I don't know exactly what I'm learning about medicine this month, but I am certainly getting a crash course in ethics.

My next patient was the opposite end of the spectrum. The resident from last night had been taking care of her so I hadn't really known much about her case. She was doing well enough after her surgery to be transferred to the rehab floor, so getting that accomplished was my goal for the morning. As I sat down to read her chart, I was surprised by what I found: this girl was from Iraq. She had been a very sickly child, who was having fainting spells that were getting worse. It turned out that she had a large defect in the wall of her heart that separates the two ventricles. Her oxygenated blood was mixing with her deoxygenated blood to the point that her body wasn't getting the oxygen that it needed. She had seen doctors in Baghdad for this, but after keeping her on medication for a year, they had stopped all treatment and told her family that the condition was inoperable.

And that's when the miracle took place. Somehow her path was crossed by a U.S. soldier who brought her here. To sum the story up, last month she got a patch placed over the defect in heart. She developed a fatal arrhythmia in the operating room, and a pacemaker was immediately inserted. Her left side is weak, and the head CT I ordered this morning explains the weakness as there is evidence of an old stroke. However, today she has a chance. Her life will never be that of a normal 9 year-old, but with therapy and some medications, she should do well. I tend to not make political comments because in general I have nothing nice to say, but today I was proud of my country.

It kind of reminded me of that tale about the starfish, where the old man is on the beach throwing the starfish he finds back into the ocean. A young man points out how they will keep washing ashore and there's no way to save them all. The old man keeps at his work, and says something like "well, it makes a difference to this one."

Changes

I just upgraded to the new version of Blogger... not because I wanted to, but because it was becoming too difficult to not switch and figure out how to continue to log in. Sorry if this is creating any problems with viewing or receiving updates, but it didn't seem like I could avoid it anymore. And thanks to those who have continued to stop by in spite of my lack of posting.

My parents left on Sunday morning. It was good to see them, although this time I was kind of at a loss for things to do with them given the weather. Currently, it's 4 degrees outside. I have been using my snow thrower pretty regularly, and can no longer leave the house without gloves and several layers of clothing.

I do take some comfort in the fact that the sun is now setting after 5 o'clock.

Since my last entry, I have started a rotation in pediatrics. I was on for a 24-hour shift yesterday, which I think is a rather rude way to introduce someone to a new floor. However, it wasn't that bad as I was on with a good senior resident. The floor is somewhat depressing, as there are some very sick children there with a couple of them having been victims of severe abuse. One had to have surgery after being stomped on, while the other's mother was caught putting water into a patient's tracheostomy collar in the hospital, thereby directly filling his little lungs with fluid.

There are good things too, such as examining playful infants, but I have a feeling I'm going to be at least a little down-spirited by the end of this four weeks. One good thing is that this is the last rotation of the year for me when I'll be taking 24-hour call. Our program only incorporates one month of call into the 2nd year and none in the 3rd year, so in a way, this month's kind of a milestone as far as sleeping in cold rooms with institutional sheets goes.

Promises, Promises

Will write again soon, just not today... or tomorrow.